Head of Household
Number of other adults
Number of children
Give True and Complete Information
I/We certify that all the information provided on household composition, income and family assets, is accurate and complete to the best of my/our knowledge. I/We have reviewed this Application Form and certify that the information shown is true and correct.
I/We understand that each adult member of the household must provide a criminal background check for every state he/she has resided in over the last seven (7) years at our own expense. Only original documents will be accepted.
Release of Information
I/We do hereby consent and authorize the release of any and all information to Concord Housing + Redevelopment from the sources listed on this application for the purpose of verifying my/our eligibility. I/We do hereby release, remise, and forever discharge, from any action whatsoever, in law and equity, all Concord Housing + Redevelopment employees and agents in connection to the processing, investigation or credit checking of this application and will hold harmless from any suit or reprisal whatsoever.
By signing below, I/We attest that all the information contained in this application is true and accurate to the best of my/our knowledge. I/We have read and understand all sections of this application.
ALL ADULT HOUSEHOLD MEMBERS 18 YEARS & OLDER MUST SIGN BELOW
Please type the names of all adult household members
Concord Housing Authority does not discriminate against any person because of color, religion, handicap, familial
status, sexual orientation, sex, race, marital status, age or national origin.
Applicant must notify CH+R of any address and/or telephone changes immediately. Failure to do so may result in
termination from the wait list.
Completed applications will be added to the wait list on the date they are received. Incomplete applications will not